title: Unrecognized carbon monoxide poisoning leads to a multiple-casualty incident.
abstract: BACKGROUND
  Carbon monoxide (CO) is regarded as a leading cause of morbidity and mortality. It endangers not only patients, but also health care professionals, especially emergency medical services (EMS) personnel because CO exposure is often unknown at the time EMS is called.
  
  
  OBJECTIVE
  Our objective was to report a case of unrecognized CO exposure during the treatment of a patient that finally led to the hospitalization of 11 EMS personnel.
  
  
  METHODS
  A 71-year-old man was found unconscious in the basement of his house. EMS was called and, due to ST-segment elevations on electrocardiogram, the patient was treated for acute coronary syndrome. Unknown to EMS personnel, ongoing CO exposure was the cause of the patient's symptoms. EMS staff finally had to be evacuated by firefighters, and a total of 12 persons, including the initial patient, had to be hospitalized.
  
  
  CONCLUSIONS
  In the prehospital setting, hazardous environments always have to be considered as potential causes of a patient's altered status. Together with the correct use of modern equipment, such as permanently switched-on CO detectors, this can help avoid harm to both patients and staff.
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Dominik
authors.initials: D
authors.lastname: Roth
authors.forename: Mario
authors.initials: M
authors.lastname: Krammel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schreiber
authors.forename: Harald
authors.initials: H
authors.lastname: Herkner
authors.forename: Christof
authors.initials: C
authors.lastname: Havel
authors.forename: Anton N
authors.initials: AN
authors.lastname: Laggner
mesh_terms: D000368:Aged; D002249:Carbon Monoxide Poisoning / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D002263:Carboxyhemoglobin / Q000378:metabolism; D003951:Diagnostic Errors; D004562:Electrocardiography; D004632:Emergency Medical Services; D006801:Humans; D008297:Male
chemical_list: D002263:Carboxyhemoglobin
keywords: carbon monoxide; coronary heart disease; emergency medical services; multiple-casualty incident; toxicology